1. Impact of a public education program on promoting rational use of medicines: a household survey in south district of Tehran, 2002-2003 Darbooy SH, Hosseini AR, Mohagheghi MA, Effatpanah M Tehran University of Medical Sciences, IRAN Problem Statement: Public education program addressing the use of medicines have not been appreciated in Iran’s health system. This study is the first that documents social behavior in relation to medicines and tries to positively change this behavior by designing and conducting a public education program. Objectives: To get insights about the public's knowledge of and behavior related to medicines and to study the effects of an educational program on drug use behavior in community. Study design: Pre and post intervention with control group. Setting and Population: Three hundred households were selected using a multistage systematic randomized sampling method for each control and study group in the Population Lab in districts 16 and 17 in south of Tehran, respectively. Data were collected from both groups pre- and post-intervention using a modified World Health Organization (WHO) household survey questionnaire. Data collectors were trained in the procedures of interviewing and checking the household medicines in a one-day workshop. Intervention: The educational program consisted of training sessions run by general physicians, in Primary Health Care (PHC) centers in the designated area, together with distribution of a booklet containing session notes to the households attending to the program. The booklet was designed, pre-tested and published based on general facts about medicines used in the community. Outcome measures: percentage of episodes of illness treated by a physician and by self-medication; drugs that people kept in their homes and their knowledge of and behavior towards this drugs ; and other indicators included in WHO guidelines for investigating drug use in communities. Results: Pre-intervention descriptive results were as follows: percentage of illnesses treated in self-medication: 19.3 and 16.3; average number of drugs per household: 7 and 4 for the study and control groups, respectively. The drugs that people most commonly had in stock were (category: study group, control group): Antibiotics: 21%, 18%; Over The Counter (OTC) : 11%, 13%; Gastrointestinal: 11%, 12%; Vitamins: 8%, 14% ; nonsteroidal anti- inflammatory drugs(NSAIDs): 8%, 7%; central nervous system(CNS) : 10%, 8%; Cardiovascular: 9%, 8%. Of total drugs stocked 27% and 21% were expired; 38% and 35% of interviewees incorrectly explained the drug indications and 58% and 60% of interviewees stored the drugs for future use in study and control groups, respectively. We are currently collecting post- intervention data and the compared results at the conference. Conclusion: So far that our program has been successful and very interesting especially for our PHC physician colleagues. This program is capable of being adopted in a national level after it has been optimized. Study funded by: Ministry of health and medical education, Undersecretary of Food and Drugs, Iran.

2. Introduction: Although prescribers play an essential role in promoting rational use of medicines, the role of the patient is equally important. Knowledge; attitude and practice of patients as the final target in pharmacotherapy cycle influence health improvement in countries. World Health Organization (WHO) has suggested educational programs as an important strategy to improve rational use of medicines in communities. In Iran since many years ago educational programs has been carried out in form of continuous medical education programs for physicians, pharmacists and other health providers. In these programs many seminars and workshops have implemented regarding rational use of medicines, but very few programs has focused on public education. A number of studies in different countries have shown effectiveness of public education in promoting rational use of medicines, but apart from a number of scattered studies, we had no documented information about public's knowledge and behavior related medicines and impact of education on promoting them.

3. Objectives: This study was undertaken to get insight about public's knowledge and behavior related to medicines and to study the effect of an educational program on drug use behavior in the community. It was expected that public education would change drug use behavior positively.

4. Methods: Study Design: Pre- and post intervention with control group. Setting and Population: Tehran municipality has divided this city to twenty two districts for municipal services. Tehran University Of Medical Sciences is responsible to health care services in southern region of Tehran including districts:10,11,16,17,19. This study has been carried out in districts 17 as study group and district 16 as control group. Three hundred households were selected using a multistage systematic randomized sampling method for each control and study group. Data were collected from both groups, pre-and post intervention using a modified World Health Organization (WHO) household survey questionnaire. Data collectors were trained in the procedures of Interviewing and checking the household medicines in a one-day workshop.

5. Intervention: An educational booklet containing simple recommendations and pictures regarding subjects such as correct use of medicines, attention to expiration date of drugs, completing treatment duration, drug abuse and disadvantages of self –medication was designed, pre tested in target group and published based on pre intervention findings. A number of general practitioners were trained about communication skills in public education regarding appropriate drug use. Study group households were invited for participating in training sessions that run by general practitioners in primary health care centers, together with distribution of booklet. Post intervention data collection has been carried out three months after training sessions in both of study and control group.

7. RESULTS: About ninety five percent of training session's participants was housewives. Local primary health care center's services were used by more than sixty five percent of households. Pharmacy was only source of drug supply in study and control group. Before intervention, respectively 58% and 60% of interviewees in study and control groups explained that reuse of drugs in probable future diseases was the main reason for storage of drugs in their homes. After intervention this option was 32% in study group and 55% in control group. Other results for pre- and post intervention surveys including: average number of drugs per household, drugs that people most commonly had in stock, percentage of expired drugs in total drugs stocked and percentage of interviewees that explained the drug indication correctly are compared in Figures 1 to 6.

8. Figure 1 Figure 2

9. Figure 4 Figure 3

10. Figure 6 Figure 5

11. Discussion: Finding of this study showed that public education about medicines, improved drug use behavior in study group in comparison with control group. Reduction in average number of drugs per households, percentage of antibiotics and expired drugs which were available in households confirmed that people attention to completing treatment duration and expiration date of drugs has increased. Self- medication as one of the irrational use of medicines indicators in the community has decreased after Educational intervention. Besides, this study showed that people were interested to know more about drugs which they used. Increased percent of interviewees that explained correctly drug indications demonstrated this point. Finally, housewives as health managers in their homes and primary health care centers and pharmacies as reliable medical services have essential role in improving rational use of medicines in the community.

12. Conclusion & recommendations: Implementation of training sessions about medicines in southern region of Tehran primary health care centers together with using of appropriate printed material, within the short period of evaluation has changed social behavior in relation medicines positively.The study needs to be followed by periodic reinforcement in this region. Besides, doing such studies in other areas with similar or different educational interventions and comparison between obtained results will give us total insight about effectiveness of these programs. By disseminating the results to health policymakers and their advocacies, public education about medicines will be as a continuous program in national level. Mass media has determinant role in success of this program.